This blog is totally independent, unpaid and has only three major objectives.
The first is to inform readers of news and happenings in the e-Health domain, both here in Australia and world-wide.
The second is to provide commentary on e-Health in Australia and to foster improvement where I can.
The third is to encourage discussion of the matters raised in the blog so hopefully readers can get a balanced view of what is really happening and what successes are being achieved.

Monday, April 14, 2014

It Seems Minister Dutton Is Committed To An Electronic Health Record. But Not The PCEHR Explicitly.

This appeared a day or so ago. See the section on e-Health Implementation below.

Standing Council on Health (SCoH) Communique - 11 April 2014

Australian Health Ministers met in Brisbane today for a meeting of the Standing Council on Health (SCoH). The meeting was chaired by Jillian Skinner, NSW Minister for Health and Minister for Medical Research.

Items discussed included:

Australian Health Management Plan for Pandemic Influenza

Health Ministers endorsed an enhanced national plan for health sector management of an influenza pandemic.The national pandemic plan of 2008 was used to guide the response to the H1N1 2009 Influenza Pandemic. Following this response, a major review was conducted. Health sector stakeholders worked closely together and a new plan was developed based on existing seasonal influenza and emergency management systems. This has made the new plan stronger, better integrated and more sustainable. The Australian Health Management Plan for Pandemic Influenza (AHMPPI 2014) also uses a more flexible approach, which allows decision makers to implement measures that are in proportion to the severity of the pandemic and tailored to the needs of Australia’s diverse communities.

20th International AIDS Conference

Ministers noted an update from Victoria and NSW on the 20th International AIDS Conference being held in Melbourne from 20 to 25 July 2014. The conference provides an opportunity to highlight the unique responses to the diverse nature of the Asia Pacific region's HIV epidemic, and to strengthen efforts across all regions and around the world. It also provides a chance to assess the current status, evaluate recent scientific developments and lessons learnt, and collectively chart a course forward.

Privately Practicing Midwives

The Standing Council on Health considered the current exemption from holding professional indemnity insurance for home births available to privately practicing midwives, which is scheduled to end in June 2015. The Council acknowledged the importance of resolving this issue from a patient and professional practice perspective, and agreed to ask AHMAC to progress measures which will improve the governance and safety of home birthing services provided by privately practicing midwives.

Organ Donation targets

Ministers reviewed the 2013 organ and tissue donation and transplantation outcomes from the DonateLife Network which showed a further increase in the organ donation rate over previous years. In 2013, there were 391 donors who made a life changing difference to 1,122 transplant recipients. This represents a 58% increase in the number of organ donors since 2009, the year the DonateLife Network was established.

Ministers discussed and agreed the national and jurisdictional indicative donation targets for 2014 and the projected donation and transplantation growth trajectories to achieve 25 donor per million population (dpmp) by 2018, noting that there has been an increase from 11.4 dpmp in 2009 to 16.9 dpmp in 2013.

Integrated care

Ministers noted the recent announcement by NSW of significant new investment in integrated care and discussed opportunities for collaboration on integration of care within the health system. Ministers agreed that collaboration across jurisdictions, including joint initiatives and shared learning, would help all parties achieve a sustainable, integrated health system that better meets the needs of Australians. Areas identified for collaboration included increased sharing of information and data.

Multi-jurisdiction clinical trials

Ministers endorsed work to identify ways to enhance clinical trial activity in Australia by implementing a national approach to clinical trials. They agreed to ask the Australian Health Ministers’ Advisory Council to conduct a scoping exercise, in consultation with the National Health and Medical Research Council, to report back on practical approaches to enhancing clinical trials activity.

Medical Intern Training

Ministers agreed to commission a Review of Medical Intern Training to examine the current medical internship model and consider potential reforms to support medical graduate transition into practice and further training. Phase one of the review will be undertaken by an Independent Reviewer appointed by Australian Health Ministers’ Advisory Council who will be supported by an Expert Advisory Panel. It is envisaged that phase one of the review will commence early in the 2014–15 Financial Year.

Childhood Immunisation and Family Assistance Payments

Ministers noted that the Commonwealth will consider issues associated with incentives to reduce vaccine refusal. Under the Commonwealth’s current payment scheme, parents who refused immunise their children on non-medical grounds are eligible to receive the same financial benefits as parents who do immunise.

Hospital Capacity Recording in Contemporary Healthcare

Health Ministers have agreed to work together to improve the consistency of reporting of public health service capacity by developing more accurate measures that are aligned with contemporary healthcare. This includes the ability to capture nationally for the first time hospital in the home services, same-day dialysis and chemotherapy chairs, capacity contracted from the private sector, as well as ambulatory care services.

A National Framework for Communicable Disease Control

Ministers endorsed the National Framework for Communicable Disease Control - a framework that, for the first time, brings together government, agencies and committees under the shared goal of strengthening our defences against communicable diseases. The Framework’s objectives are to improve national prevention, detection and response to communicable diseases and to improve the organisation and delivery of communicable disease control. The Australian Government and state and territory governments, through the Australian Health Protection Principal Committee are developing implementation options for the Framework.

eHealth Implementation

Ministers heard from the Commonwealth Minister for Health, Peter Dutton that the government had ordered a review of the Personally Controlled Electronic Health Records and had received the review report and recommendations.

The Minister said there were a number of concerns identified in the report, including clinician engagement and the government is working through the issues.

All Health Ministers supported the concept of the PCEHR but agreed that there was work to be done on making this a much better system that is properly coordinated and really works.

Minister Dutton said the Commonwealth is committed to an electronic eHealth record and will be working with the states and territories to implement it properly.

National Blood Supply

Ministers approved the 2014–15 National Supply Plan and Budget (NSP&B) of $1,156 million. The NSP&B is cost shared by all jurisdictions with Australian government contributing 63 per cent and states and territories 37 per cent.

Review of the National Registration and Accreditation Scheme (NRAS) for Health Practitioners

Ministers determined that the NRAS Review will be undertaken by an independent reviewer; an eminent person with expertise in health and practitioner regulation.

Health Ministers are pleased to announce the appointment of Mr Kim Snowball as the independent reviewer for the NRAS Review. Mr Snowball has held a variety of senior leadership roles in both the public and private health sectors. Mr Snowball was previously the Director General of WA Health and has also served as the Chair of the Australian Health Ministers’ Advisory Council (AHMAC).

National Health Practitioner Ombudsman and Privacy Commissioner

Ministers agreed to seek funding from National Boards for the ongoing costs of the National Health Practitioner Ombudsman and Privacy Commissioner without the need for fee increases.

Ministers heard from the Commonwealth Minister for Health, Peter Dutton that the government had ordered a review of the Personally Controlled Electronic Health Records and had received the review report and recommendations.

The Minister said there were a number of concerns identified in the report, including clinician engagement and the government is working through the issues.

All Health Ministers supported the concept of the PCEHR but agreed that there was work to be done on making this a much better system that is properly coordinated and really works.

Minister Dutton said the Commonwealth is committed to an electronic eHealth record and will be working with the states and territories to implement it properly.”

I read this to say that the PCEHR is not ‘really working’, has a range of problems that are not yet solved - so they are tricky or they would have been quickly fixed - and that the program is not well co-ordinated and has not been implemented properly.

I also read this to say the Government is committed to an electronic eHealth record, and not necessarily the PCEHR or they would have said so!

I too have studied the modus operandi of the bureaucracy in depth at great length. I believe you will find that when the Review is released the Recommendations will have been modified to dovetail in with the sanitized findings which support past efforts that have given us solid foundations upon which to build a way forward to achieve the next 5 years strategic plan in keeping with the original goals and objectives laid down for NEHTA at the outset 7 years ago when Dr Ian Reinecke was appointed. As you said - you can learn a great deal by understanding bureaucrateze!

I recently participated in a workshop meeting with Haldon and Royle where the distinct impression given is that the PCEHR project is "our toy" and "we determine where it is going". They are very closed shop on 'interrogation' about the project. From what I 'understood' they were saying the whole process of implementation has significant flaws independent of the PCEHR 'structure'. Also the NSW Health Minister gave the opening address on some of that State's e-health projects and it would seem that 'measurable outcomes' are not readily available. Rollout numbers of projects is equated with 'success', not necessarily better care.These are my opinions and are very unlikely to have no value in these discussions but it is nice to have a forum to make them public.

Terry Hannan is absolutely correct when he says .... I recently participated in a workshop meeting with Haldon and Royle where the distinct impression given is that the PCEHR project is "our toy" and "we determine where it is going".

This is to be expected. Think about it. The PCEHR is perceived by these people as the holy grail - they believe they alone can deliver where others have failed.

The reason is - their EGOs are all powerful and have overridden their Super Ego's (the policeman)leading them to a monomaniacal belief in themselves to the exclusion of others. Another truckload of money is likely to be wasted on people like this unless Treasury steps or the States say enough is enough.

Here's proof that an ego, even a superior ego, may be split three ways, each acting independently of the other two alter egos. From UPDATE ON CLINICAL DOCUMENT ARCHITECTURE AND E-HEALTH RECORDS"NEHTA, the Department of Health, and the PCEHR System Operator identified and considered these issues some time ago and as a result put in place actions to either negate or mitigate them."Would have been more concise and more accurate to write "Professor Halton identified ...."